Predictors for Better Blood-Flow Restoration of Long-Segmental Below-the-Knee Chronic Total Occlusions after Endovascular Therapy in Diabetic Patients.
10.3348/kjr.2016.17.6.874
- Author:
Xiao Li SONG
1
;
Yue Qi ZHU
;
Hai Tao LU
;
Fang LIU
;
Li Ming WEI
;
Heoung Keun KANG
;
Jun Gong ZHAO
Author Information
1. Department of Radiology, Chonnam National University Medical School, Gwangju 501757, Korea.
- Publication Type:Original Article
- Keywords:
Chronic total occlusion;
Extremity;
Below the knee;
Endovascular treatment;
Blood flow restoration;
Diabetes mellitus;
DM
- MeSH:
Angioplasty;
Diabetes Mellitus;
Extremities;
Follow-Up Studies;
Humans;
Ischemia;
Logistic Models;
Myocardial Ischemia;
Odds Ratio;
Prevalence;
Prospective Studies;
ROC Curve
- From:Korean Journal of Radiology
2016;17(6):874-881
- CountryRepublic of Korea
- Language:English
-
Abstract:
OBJECTIVE: To prospectively investigate predictors for good restoration of blood flow of below-the-knee (BTK) chronic total occlusions (CTOs) after endovascular therapy in diabetes mellitus (DM) patients. MATERIALS AND METHODS: A total of 120 long-segmental (≥ 5 cm) BTK, CTOs in 81 patients who underwent recanalization were included in this study. After angioplasty, blood-flow restoration was assessed using modified thrombolysis in myocardial ischemia grades and classified as good flow (grade 3) and poor flow (grade 1/2). One hundred and six CTOs with successful recanalization were divided into a good flow group (GFG; n = 68) and poor flow group (PFG; n = 38). Multivariate logistic regression analyses were undertaken to determine independent predictors of blood-flow restoration. Receiver operating characteristic curves were constructed to determine the best cutoff value. The prevalence of target-lesion restenosis during follow-up was compared between two groups. RESULTS: Univariate analyses suggested that CTOs in GFG were characterized by lighter limb ischemia (p = 0.03), shorter course of ischemic symptoms (p < 0.01) and lesion length (p = 0.04), more frequent use of intraluminal angioplasty (p = 0.03), and higher runoff score (p < 0.01) than those in PFG. Multivariate regression analyses suggested that distal runoffs (p = 0.001; odds ratio [OR], 10.32; 95% confidence interval [CI]: 4.082–26.071) and lesion length (p < 0.001; OR, 1.26; 95% CI: 1.091–1.449) were independent predictors for good flow restoration. Kaplan-Meier analyses at 12 months showed a higher prevalence of non-restenosis in GFG (p < 0.01). CONCLUSION: Distal runoffs and lesion length are independent predictors for good flow restoration for long-segmental BTK, CTOs in DM patients who receive endovascular therapy.
